HomeMy WebLinkAboutBuilding Permit #923 - 35 MAY STREET 6/18/2014TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:W/k/
IMPORTANT: Applicant must complete all items on this page
LOCATION.
Print
PROPERTY OWNER
Print 1 00"Year Old SttdctuYe yes, no
MAP NO: NZ PARCEL76W ZONING DISTRICT: Historic District yes no
Machine Shop Villaqe.
yes no
.TYPE OF IMPROVEMENT.
PROPOSED USE
Residential
Non- Residential
0 New Building
0 One family
El Addition
0 Two or more family
11 Industrial
0 Alteration
No. of units:
El Commercial
0 Repair, replacement
0 Assessory Bldg'
0 Others:
0 Demolition
El Other
0 Septic 0 Well
0 Floodplain 0 Wetlands
0 Watershed District
0 Water/Sewer
DESCRIPT!PN OF WORK TO BE PERFORMED:
1-1. - - 0- 0 _. - -� --- r) — �2 0 ., 'd
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Ar1r1race-
CONTR/
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License:
ARCH ITECT/ENGI NEER
Date:
Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT., $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON$ 5.00PERS.F.
Total Project Cost:$ 2_�
ff FEE: $
Check No.: -2-3 Receipt No.:_7_-i(,oco
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
,�gent/ wner of contractor
Plans Submitted 0 Plans Waived Certified Plot Plan El Stamped Plans El
Plans Submitted -11 Plans Waived El
Certified. Plot Plan El Stamped Plans" El
W - -�OF - -E -AG
E ---SEW - R EDISROSAL
Public Sewer
Tanning/1\4assage/Body Art El.
swimming Pools
Well El
-Tobacco.Sales
Tood Packaging/Sales 11
Private (septic tank, etc..
--Permanent Dunipster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
.:,-.,DATE REJECTED
PLANNING &'DEVELOPMENf' El
DATEAPPROVED
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
'HEALTH Reviewed on Simature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: —Zoning Decision/receipt submitted yes_..
Planning Board Decisio n: Comments
Conservation Decision: :Comments
Water & Sewer Con nection/Signature & Date Driveway Permit
DPW Tow;2 Engineer: Signature:
":F.1kE:DtP-AKTM'.F-;-,Nt --`Te'ffip`D1u*fh* p�§t'6* r* on "site--
Located'bt 124,Mair, Strdet,-
'Fire-be-pa rne�if�§ighdt&e/dzitd''
COMMEWS
Located 384
no
Street
j - I I
-Dimension -
Number of Stories:- Total square feet of floor area, based on Exterior dimensions.
Total land -area,- sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL-Chapterl66 Section 21 A —F and G min.$100-$1000.fine
NOTES and DATA — (For department use
I
El Notified for pickup - Date
Doc.Building Permit Revised 20 10
Building Department
-The fd'owing ig-a- list of the req-ulred forms to be'filled out foe the appropriate. permit to:be obtained.
Roofirig, Siding, Interior Rehabilitation Permits
u Building Permit Application
u Workers Comp Affidavit
u Photo Copy Of H. 1. C. And/Or- G. S." L. Licenses
u Copy of Contract
u Floor Plan Or Proposed Interior Work
u Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
Li Building Permit Application
• Certified Surveyed Plot Plan
• Workers Comp Affidavit
• Photo Copy of H.I.C. And C.S.L. Licenses
Ei Copy Of Contract
• Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
• Mass check Energy Compliance Report (If Applicable)
• Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
u Building Permit Application
Ei Certified Proposed Plot Plan
• Photo of H.I.C. And C.S.L. Licenses
• Workers Comp Affidavit
• Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
• Copy of Contract
• Mass check Energy Compliance Report
• Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of. Bldg Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the apwal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submAted with the building application
Doc: Doc.Building Permit Revised 2012
Location
No. 4� 3 -/ v Date
Check # 2-'!�
27690
TOWN OF NORTH ANDOVEFr'
Certificate of Occupancy $-
Building/Frame Permit Fee $�Av
Foundation Permit Fee $-
Other Permit Fee $-
TOTAL $
Building Inspector
.0 C)
uv (D
E
0
0.
E
0
0
#A
0
c 3:=
0 —
=1 0,
V)
C4
w Cc t,70
$
:p > S
0
tio
.2
c:
0,
C14
'A
L.
41
in
04
Ln In
E 0
0 �O
4
lu<
-C
C6
v
0 C
-W 0
CO cc
0 0
00
Ln Ln
0 0
CL N
6
0
Q
E
0
0.
E
0
0
#A
pp-:
id
0
,Z. -
4mo
0
C,
rA
rA
S9-*
q I
07�
mow
1
C401
ev
kt4v
r
0
CU
X 0
E
cn
r_
CD
E
40: a
rL c
**:3r'; u) -j
cn '00 -00
cl)
CL U)
.2
U)
tm > o
0
r.L
CL
(1)
Cm)
L)
(D
CD CL
0 U)
cn
LU -0 0
E: . 2 S! Ig 0
u1i cL :E .2
E U-0 r 0
LU 0 (D .— p
0 -0
CL
CO
ri m 0
o " c 0
4Z CL 0 L)
E
L-
CD
IL
0
.2
Fa
0
LU
CL
cn
:z
Cf)
Z
0
LLI
CL
x
LL, 0
F- C-)
cn
Cl)
LU
ui —i
0-
Z�-
�2
0
E
0
z
0
C
lw
0
01—
co
00 L- L-
0 CL
CL
AM<
Cc
0
z
CL
(n
0
0
F-
u
u
u
LU
cc
0
z
LLI
<
LU
LLI
F-
z
z
z
LU
F -
LL
0
z
z
LLI
co
F-
I^
LLI
5
co
E
:) '
co
D
i
u
U.
cu
(U
LU
0
ai
6
z
_0
tl E
u
70
aj
0
0
0-
cu
:3
0
o
D
0 C:
0 G)
0
L�
V)
Ll-
cr U Ll-
cr U-
CC V) E
1= L.L
ca Ln
r
0
CU
X 0
E
cn
r_
CD
E
40: a
rL c
**:3r'; u) -j
cn '00 -00
cl)
CL U)
.2
U)
tm > o
0
r.L
CL
(1)
Cm)
L)
(D
CD CL
0 U)
cn
LU -0 0
E: . 2 S! Ig 0
u1i cL :E .2
E U-0 r 0
LU 0 (D .— p
0 -0
CL
CO
ri m 0
o " c 0
4Z CL 0 L)
E
L-
CD
IL
0
.2
Fa
0
LU
CL
cn
:z
Cf)
Z
0
LLI
CL
x
LL, 0
F- C-)
cn
Cl)
LU
ui —i
0-
Z�-
�2
0
E
0
z
0
C
lw
0
01—
co
00 L- L-
0 CL
CL
AM<
Cc
0
z
CL
(n
-A
IF UABILIfY INSURANCE"'
ICATE OF
0,TTER,
_,9F,pt�"
vo CT�kp -YOPAtGATIVELif - %gHSS'.
, - . -M 9L AMEDIM"EXTEND. OR ALTER THSCOVERAGE AFFO'R1wD-B-Y--TM�
�-WT -CCMY� A CONTRACT BETWEEN Tht -ZSWM'N4SURER(8j AUTRORtZE0.
A -ME "ERTIMATE MbLbtik.'
MUNWAMr. N
mquim fin andorseaMIL.. A -statsaw" on
ey
adWcat� MIdeflit'Reu of such -endo�p ceititicki, da*'not confer rights to the
COMACT
Jerrold Rameras
MSMUMM' ACWCY INC.
.(978) -7*5,4965.- PAX
-1/2 ': .7". - :jgje 197fl 145-S483.-
63 cc
MEN MAIC 0
AAS ;0Ci*&t1&d
9KSUR lua: co
-----TGLRC
MUNgRdWationa
a uAi C6.,:
NLMLRER 6 -Me. 'ft.V1jQ �j
--.-r ca*n j:ns1%rance_Co...'_'.
4-A— lim
Has -hi
MES--
-C� A
FIC -TSWUMBER-,
-CERTIF
_Y...-TMAT-THE., JuMal :7 To
L(STSD:BELGW HAVE BEEN
-'WGTWTHSTANbIW MMOVIA- TH9 INSURED* NMED
x
-.x
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
A LAW"
hk91028029— 11 22;2 4
2"40040
4 JES PER
Locl-,-I.— A .0
Pa�CYFI M F p -�COMPIOPAGG S.
COMSMOSINGLE.
B ANY AUTO, .0.00 ann
x ALL Ov
AUTOS 44ED 80PX-Y 94MY (P4 innon). S
0
NON-OWWO 07116/�0.13 7/.1642024. S
S
..... . ... ...
P
EAGH4C
C X 6tixiiUA0 3203=221435 ENCE' 5
V%1'12013 11/121,2014
.0
13ATE
-QED-j 1. 1
RErENTMUS 7
PAW, Mcih�
0—C
AWD1WMoftFtW-M&]u-
�y f X M STATU-
OFF, 1�22?/,20;13 dja4
D
bi
NH? 1.* 0:0
tc
PL, S -.1 000
r: C oiSWj�.,-�
era -�Coavr-.&- imp
-,,Oy;e;* . . .
re
S62UB75090'312 12 2 2 t2O-3a U-/2ij�
;kIW4 hirft*as move:
"ability.. or Im.
0 04.,
owfuPTM OF QPMTMS 1,WCATKM I MUG
IM-.PA&ckAC.OXD.Iol.AdCkwWRUMuftSchadW.. Irmo= xPw*15 MWftd)
CM;ffMAM 1401bER
CANCELLAh6m.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEI I ED BEFORE
THE EXPIRAMON DATE THEREOF; jjO710E -,MLL at. 'rj D, N
Lambert-'Rodfing Co. ACCORDANCE WITH THE POLrCY pgaVMOM.
AUTMORM
ENTATME
Wjut�er St
rest
-kh. 01810-
ACCARV
A
r
Hav-ertiill
ACORD 26tt201=5) -
0198
INS025(201005)01 8-2010 AGORD TION. All ri4hts4se--rv-ed.--
The Aeon nar-ne and logo are nigi red marks of ACORD
Consum
0/
er Affairs 41,etZ V
and Business
.-Ke�guiation
10 Park Plaza - Suite 51.70
Po';4014�saehusetts-02
Honle hnprovem
ent Contra
Otor �ejistration
Nezz.:;F
,2
G.L.R.C-dba pe,
ME
0
RICHARU.,LX, bfffl
1
9FQq
4
21 7 %F
SCAI a 20WOM
�U.
Pdaft
Addk id
kc
d
&B
VEMENTCO rale. or regbbig-
WMCTOR 01� -Valid fo�
04., before the.ewra
.!!Ol kwe qj
ype:
Office of CI) deft lfib6d return'to:
......... P"vate Corporation 10 Park pi n"Mer Afrain and B"en
Applation
'd.baLambert an - Suite 5170
Roo� company Rostom, MA 02116
PJCHARD LAMSERT
206 WlPiMR STREET
HAVERHILL, AdA 01&M
Not valid whhout
t6re
Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Construction Sulper� ;,,,r
License� C."78130
1:01
RICHARD J LANMR
265 WEKTER. STREE
HaverM MA 01930
Expiration
Commissioner 0610212016
Jun.10. 2014 12:51PM No -0214 P, 2
May.20.2014 09:36 AM LAI�MERT ROOFING CO. 9785215791 PAGE. 2/ 3
Ch n,� T.
LIN 4 51-050-3313 Haveittl MA078,374.9224
RA Rej� IMIC. # 149221 jAwrerce MA 978.687.7339
Hamptun NH 603.929.9224
air, MA Lic. UCS W 701-10
"9 liartipstead Nil 603.329=0
EBIBB, 51jigIv-Ply Licensed 1711 MTN
st
.�,193 e
32 0. V1 PM 1.8".50S.1100F
Co.
265 Winter Street
Haverhill. MA01830
*Ijmsed Qnsured *Faccary Trained kFaclory Comifted r
, f, CiAla
Billina Addrass: Pre, ___state
JdbAddrcm; —City: tate:
scope of Work �_Ilsjtjp and Re -roof C3 Re -roof Approximate Roof Area:
* Prepare for re-ro6fing by ensuring all safety measuiv5 in accordance with OSHA sondot regulations and landscape is properly protected-
* Remove existing layers of shingles down to roof duck and dispose of in a legal fashion from tho * b site.
* inspect wood deck, if we discover any rotted wo(id, replacement will will perfofted at *$-3,Th per LF for rooidecIt boards. If
substanilkil deck rat is discovered, re-sheRthing of roof deck can be performed at *$_W60 __ per 8F. If individual sheets are found to be
ootted/or &-lamitiaTed, removal, disposal and, replacement will he performed in .$� -* Y-9- per sheet. if ally Irlin bnar& are romed,
replacement will be performed at*$ 12A� -per LF for new pre -primed pine, inspect gidingat roof 11pe and all flaskilng behind siding, if
we discover any damaged flasWipg Or siding at the rouf line, replacement will be performed at *j_jZf__ it- wood deck, siding, and
flashing is sound, we will fe-nail dny laoso wood to rafters, slylep deck., and prepare for roofing.
* install 811 drip edge to all takes and mves. CAilor 1, � I Te, e-0
* Apply ice & water shield l[UNDERLAYMENT) as per manufacLaren'sPilcificatiOTIN and/or
13 Apply premium VJNDERLAYMENT) to the balance of the exposed wood deck.
0 Re -flash all plumbing stack pipgs, and any roof penetrations as requimd and Ellctated by good roof Practice to en�"A ter tightness.
13 If upon Inspection, vie (11scover chimney lead to be wom or deteriorated, replacement will be performed at * `6 I'll, A
ral a Designer Color
w Install anew: 3D__ year Ll Architectu
0 Fumish and Install a new shingle over style ridge vent system u soffit vent system OS—,
0 All debris generated by Litinhert Roofiq Co., Inc. will, tm cleaned upand disposed of fmni the job site In a le;gal fashion. Under no
drcUmsLqncr_q wilijite watertight integrity of the buildin�be c9ma Lnis
SpecialNows 5�rj 12 are4s. p43 Q_nrl�
I I � I % --' - I -it I — --r - 1 —1 , I A. --j
N !��_ Z I= e4r_ALM-_�04 �- - 4 k J� J
upoi4COMPLE'rIONANDPAYME IN FULL, ROOF SHALL HAVE AWORKMANSHIP 66ARANTEE FOR A PERior) OPJD—
ypARS HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANY AND —.1SYEARS HONORED AND ISSUED BY THE
SHINGLE MANUFACTURER. 0 MANUFACTURER LTPGRA13E
*Dowtvi, I)atendal ad"altal costs above the total ndmated price.
TOTAL CONTRACT PRI ' CE AND PAYMENT SCHEDULE
ibe Contracior agrees to perform the work, furnish the materials and labor sWilled above for the total sum of:
PayinenE will be inade a=tding to the fallowilig wark.,whkdule:
$ dapovit upon signing contract
by or UPCIA completion of
,F,'" (1)0'Wa
$ upon complWon Af Contract.
(Law forbids dem2nding full payment Witil ConlraCL 15 COMPiet6d to both party's saitsfacdon)
You rnay caticel this agreement if it has been si$ned at a place other than the Lontractor't nornial place of bustrions. provided you notify the
contractor in writing at his/her main office or branch office by ordinary nnail posted, by telegmm or by delivery, not later than midnight a F
thW business day following thesigning, of this agt*eksiant. See attached notice of cancellation for for an explanation of this right,
Home O.wner(�) Signature(s):
IDO NOT SIGN THIS CONTRACT IF THERE ANY BLANK SPACES
t I r\ Acceptance of the Contract Proposal
Date:' Li I t
Contractoft Signakuve; Date, ./ �J,
a�wber�mat�inzco�m (Please see reverse side)
The Commonwealth ofMassachusetts
Department oflndustriqlAccW�ts
Office of Investigations
600 Washington Street
Boston, AM 02111
kvi www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Buflders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le2ibly
NaMe CBusiness/OrganizatiorAndividual):
Address:
City/State/Zip: Phone#:
Are you an employer? Check the appropriate box:
Jemployees
Type of project (required):
Xam a employer with 0V
4. El I am a general contractor and 1
6. El New construction
(full and/or part-time).*
have hired the sub -contractors
7. E] Remodeling
I am a sole proprietor or partner-
listed on the attached sheet. I
ship and'have no employees
These sub -contractors have
8. n Demolition
working for me in any capacity.
workers' comp. insurance.
5. El We are a corporation and its
9. E] Building addition
[No workers' comp. insurance
required.]
officers have exercised their
10. El Electrical repairs or additions
3. 1 am a homeowner doing all work
F1
right of exemption per MGL
11. 0 Plumbing repairs or additions
myself. [No workers' comp.
c. 152, § 1(4), and we have no
12.E] Roof repairs
insurance required.] t
employees. [No workers'
13.[i Other
comp. insurance required.]
'Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information.
T Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such.
TContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
lam an employer that isproviding workers'compensation insuranceformy employees. Below is thepollcy andjoh site
information. ./I A
Insurance Company Name:.
Policy # or Self -ins. Lic. 9: Expiration Date:
Job Site Address: C tate/Z*
I ity/S ip
Attach a copy of tiie workers' compensation -policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one"year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do h ereby certify under A e pains an dpenalties ofperjury th at th e information pro vided above is true and correct.
Official use only. Do not write in this area, to he completed by city or town offIcIal.
City or Town:
Permit/License 0
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their ernployees.
Pursuan t to this statute, an employee is defined as ". ... every person in the service of another under any contract ofhire,-
express or implied, oral or written."
An employerls defined as "an individual, partnership, association, corporation or other legal entity� or any two or more
of the foregoing engaged in ajoint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced -acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdiv�ions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is. required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be retained to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Pleas ' e be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one, affidavit indicating current
policy M"formation (if necessary) and under "Job Site Address" . the applicant should write "all locations in (City or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is* on file for future permits or licenses. A now affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or' -permit not related to any business or commercial venture
(i.e. a dog license or p* ermit to burn. leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations . would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commouwealth of Massachusetts
Department of Industrial Aceidents
ofiRce of Investigations
600 Washington Stroc,-t
Boston, MA 02111
TeJ, # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax # 617-727-7749
_www-wass,govldia